Ineligible For Obamacare, Immigrants May Continue To Face Debt And Poor Health

Maria Cabrera listens to Kate O'Donnell explain the Presbyterian Hospital application process for financial assistance at Casa de Salud Family Medical Office. Cabrera has acquired medical debt beyond her ability to pay after suffering from a heart attack, and living with severe asthma. O'Donnell is a project coordinator who helps people with severe medical debt manage their accounts with hospitals and collection agencies.

Credit Natalia Jacquez

Maria Cabrera owed $57,000 dollars after she suffered a heart attack and ended up in an Albuquerque hospital.

“Once I was out of the hospital, I got completely in debt,” Cabrera said. “The debt was so large that I don’t even know what’s going on.”

A large amount of that debt was cut down through financial assistance, but she says the debt collectors are still calling, and she’s unclear of just how much she owes.

“It’s more difficult to live with this situation than it would be if I would have died and it all would have ended,” Cabrera said. “I wouldn’t have to deal with this: living in debt that’s so high and living with such a difficult situation.”

One in four families in America currently faces medical debt. The Affordable Care Act aims to curb issues with health care access, and in turn lessen debt. But in an Obamacare America, some populations continue to be barred from access and could still be facing mounting bills.

Cabrera’s story isn’t uncommon, but the twist here is her immigration status. She’s in the country legally, with documents, but has been waiting for her green card for almost 13 years. Because of her status, she’s ineligible for Medicaid and cannot work. That means she can’t pay her bills.

“I don’t want to downplay the importance of the Affordable Care Act and expanded Medicaid — it’s going to provide care to a lot of people — but still, in Bernalillo County, we’re going to have this incredible gap,” said Kate O’Donnell, a Promotora, or community health worker, in Albuquerque and Cabrera’s medical debt case manager. “We’re going to have a lot of ill, very low-income people who are going to be in this situation, trapped in a situation that they didn’t choose and cannot get out of.”

An estimated 60,000 residents in New Mexico continue to lack access to affordable health care because they can’t afford a cheap plan on the exchange, or because of their immigration status.

“I don’t anticipate the number of clients that I serve going down,” O’Donnell said. “I anticipate it going up. I don’t anticipate being out of a job soon, anytime, ever.”

“The population that a lot of people are focusing on is the population that is undocumented immigrants,” said Rachel Garfield, a senior researcher for the Kaiser Family Foundation. “These individuals are not eligible for any assistance under the law and in some states, that accounts for a notable share of the uninsured population.”

It’s estimated that some 85,000 undocumented immigrants live in New Mexico — across the Southwest more than 4.5 million — which means, even as the Affordable Care Act rolls out, a sudden illness for many will mean medical debt. And more debt means that patients postpone care because of the mounting costs.

“Clients who have medical debt are less willing to go to the doctor again for a different treatment, and also to continue the treatments that they have been prescribed,” O’Donnell said.

Like O’Donnell's client, Maria Cabrera.

“There are appointments I don’t go to anymore,” Cabrera said. “They just pile up more debt and I don’t want to go anymore. There are times when I just play deaf when I get calls reminding me that I have an appointment. I don’t want to go anymore. It just adds more debt.”

Cabrera says she wakes up every morning and searches for some form of work so she can pay her bills. But the collections agencies keep calling, and she keeps waiting for her green card so she can finally gain access to health care.